Conc of Pathophys Case Study 1

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Assignment Instructions: 

· Review the case study scenario below and the client's family history and medical profile information from unit 1.  

· Next, write a 6-8-page paper analysis of the client (including title and reference page) according to the assignment specifications, outline, and grading rubric. 

Case Study 1 Scenario:

Client, Sarah Collins, has chronic kidney disease. She receives dialysis twice a week. Today when Mrs. Collins arrives at the dialysis clinic, the nurse assesses Mrs. Collins and notes her blood pressure is 145/90 mm Hg and she has gained three pounds since her last visit. Mrs. Collins tells the nurse she was trying earlier to walk to her mailbox at the end of the driveway and couldn’t because she was out of breath. Mrs. Collins' husband and 16-year-old grandson are at the clinic with her. 

Case Study Analysis Assignment Outline: 

 The case study analysis paper should include the following sections with responses and rationales for all the prompts.

Introduction (3-5 paragraphs) 

Provide an overview of the pathophysiology of the disease exhibited by the client. Include: 

· What additional assessment findings would you look for? 

· What lab abnormalities would you expect to see? 

· What diagnostics would you anticipate the healthcare team ordering? 

· Provide a rationale for your answers. 

Implications for Self-Care (2 paragraphs) 

· Consider Maslow’s hierarchy of needs and describe where the client falls in that hierarchy and how this will impact care and healing.  

· How does this disease process impact the client’s and/or their care provider’s ability to care for themselves? 

Patient Education Strategy (2-3 paragraphs) 

· Identify 3-5 appropriate nursing interventions and teaching points for your client based on the pathophysiology and assessment findings. 

· Describe the educational strategies that should be incorporated when building a plan of care for your client. 

· Support with rationale. 

Interdisciplinary Collaboration (2-3 paragraphs) 

· Identify 2-4 interdisciplinary team members who need to be included in the care of the client. Include rationale. 

· Consider the care the client will need while inpatient and upon discharge.  

· Consider nutrition, community services, and financial implications. 

Conclusion 

· Summarize the key concepts of this disease process and client case study scenario.  

References 

· A minimum of three references should be used in this paper.  

· References should be no more than five years old. 
Exceptions include seminal works, such as original publications by nurse theorists.  

· One reference must be your textbook, 

· One reference must be from a peer-reviewed journal,  

· One reference must be from an authoritative website such as the CDC, NIH or Healthy People 2030.

Assignment Specifications: 

· Name the paper with a File Naming Protocol: When you save the paper, name it: LastName_NSG 3300_CaseStudyAnalysis_1.docx 

· Paper reflects clinical and professional client/cases, and no references to personal or family issues.

APA Formatting 

· All papers should be written in APA formatting. This paper should include: 

· Formal components, such as a title page, and APA formatting with an introductory and conclusion paragraph that summarizes the key concepts 

· APA-formatted 
level headings 

· APA margin, font, and paragraph spacing 

· Include page numbers 

· Appropriate in-text reference citations 

· A reference page, in correct APA format 

Present your approved intervention to the patient, family, or group and record a 10–15 minute video reflection on your practicum experience, the development of your capstone project, and your personal and professional growth over the course of your RN-to-BSN program. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.

Baccalaureate-prepared nurses have many opportunities to reflect on their contributions to patient care outcomes during clinical experiences. Research suggests that creating and sharing video reflections may enhance learning (Speed, Lucarelli, & Macaulay, 2018).

For this assessment, you’ll present your approved intervention to the patient, family, or group and reflect on various aspects of your capstone practicum experience. Such reflection will give you a chance to discuss elements of the project of which you are most proud and aspects of the experience that will help you grow in your personal practice and nursing career.

Reference

Speed, C. J., Lucarelli, G. A., & Macaulay, J. O. (2018). Student produced videos—An innovative and creative approach to assessment. 
Sciedu International Journal of Higher Education, 7(4).

Complete this assessment in two parts: (a) present your approved intervention to the patient, family, or group and (b) record a video reflection on your practicum experience, the development of your capstone project, and your personal and professional growth over the course of your RN-to-BSN program.

Part 1

Present your approved intervention to the patient, family, or group. Plan to spend at least 3 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Be sure you've logged all of your practicum hours in Capella Academic Portal.

The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the
 BSN Practicum Campus page for more information and instructions on how to log your hours.

Use the 
Intervention Feedback Form: Assessment 5 [PDF]
 Download Intervention Feedback Form: Assessment 5 [PDF]as a guide to capturing patient, family, or group feedback about your intervention. You’ll include the feedback as part of your capstone reflection video.

Part 2

Record a 10–15 minute video reflection on your practicum experience, the development of

your capstone project, and your personal and professional growth over the course of your RN-to-BSN program. A transcript of your video is not required.

You’re welcome to use any tools and software with which you are comfortable, but make sure you're able to submit the deliverable to your faculty. Capella offers Kaltura, a program that records audio and video. Refer to 
Using Kaltura for more information about this courseroom tool.

Note: If you require the use of assistive technology or alternative communication methods to participate in these activities, please contact 
[email protected] to request accommodations. If you’re unable to record a video, please contact your faculty as soon as possible to explore options for completing the assessment.

The assessment requirements, outlined below, correspond to the scoring guide criteria, so address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for supporting evidence.

· Assess the contribution of your intervention to patient or family satisfaction and quality of life.

· Describe feedback received from the patient, family, or group on your intervention as a solution to the problem.

· Explain how your intervention enhances the patient, family, or group experience.

· Describe your use of evidence and peer-reviewed literature to plan and implement your capstone project.

· Explain how the principles of evidence-based practice informed this aspect of your project.

· Assess the degree to which you successfully leveraged health care technology in your capstone project to improve outcomes or communication with the patient, family, or group.

· Identify opportunities to improve health care technology use in future practice.

· Explain how health policy influenced the planning and implementation of your capstone project, as well as any contributions your project made to policy development.

· Note specific observations related to the baccalaureate-prepared nurse's role in policy implementation and development.

· Explain whether capstone project outcomes matched your initial predictions

·

· Discuss the aspects of the project that met, exceeded, or fell short of your expectations.

· Discuss whether your intervention can, or will be, adopted as a best practice.

· Describe the generalizability of your intervention outside this particular setting.

· Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.

· Assess your personal and professional growth throughout your capstone project and the RN-to-BSN program.

· Address your provision of ethical care and demonstration of professional standards.

· Identify specific growth areas of which you are most proud or in which you have taken particular satisfaction.

· Communicate professionally in a clear, audible, and well-organized video.

Additional Requirements

Cite at least three scholarly or authoritative sources to support your assertions. In addition to your reflection video, submit a separate APA-formatted reference list of your sources.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 2: Make clinical and operational decisions based upon the best available evidence.

· Describe one's use of evidence and peer-reviewed literature to plan and implement a capstone project.

· Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.

· Explain whether capstone project outcomes matched one's initial predictions and documents the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Document the completion of nine hours of practicum time.

· Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.

· Assess the degree to which one successfully leveraged health care technology in a capstone project to improve outcomes or communication with a patient, family, or group.

· Competency 5: Analyze the impact of health policy on quality and cost of care.

· Explain how health policy influenced the planning and implementation of one’s

·

· capstone project, as well as any contributions the project made to policy development.

· Competency 7: Implement patient-centered care to improve quality of care and the patient experience.

· Assess the contribution of an intervention to patient, family, or group satisfaction and quality of life.

· Competency 8: Integrate professional standards and values into practice.

· Assess one’s personal and professional growth throughout a capstone project and the RN-to-BSN program.

· Communicate professionally in a clear and well-organized video.

Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Unit 7: Initial Discussion-Case Study RM

· A 70-year-old woman has scheduled an initial evaluation with you. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression. Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years. 

· Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  

· During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present.  After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

Subjective: 

CC: initial evaluation 

HPI: A 70-year-old female presents to the clinic for initial evaluation. She is a new patient in the practice. She reports a current history of hypertension, hyperglycemia, mild obesity, and hyperlipidemia. She also reports currently being diagnosed with anxiety and depression. She reports taking atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and ability 5 mg daily for 6 years for depression. 

PMH: Hypertension, hyperlipidemia, hyperglycemia, mild obesity, anxiety, and depression.  

Allergies: none reported 

Medications: atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and Abilify 5 mg daily for 6 years for depression. 

SH: Patient lost her husband seven years ago and became depressed. The patient reports her anxiety increased to perform everyday tasks without her husband. The patient states, that after starting Abilify she gained 25 pounds and required an increased dose of atorvastatin and Ozempic.  She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

FH: N/A 

Health promotion and maintenance: N/A 

ROS:  

Constitutional	reports weight gain of 25 lbs.
Head	N/A
Eyes	N/A
Ears, Nose, Mouth, Throat	N/A
Neck	N/A
Cardiovascular/Peripheral Vascular	N/A
Respiratory	N/A
Breast	N/A

Gastrointestinal	Reports increased cravings for carbohydrates.
Genitourinary	N/A
Musculoskeletal	N/A
Integumentary	N/A
Neurological	Alert and oriented x 3.
Psychiatric (screening tools: Ex: PHQ-9, MMSE, GAD-7)	Reports anxiety to go out of her house alone and depression slightly improved
Endocrine	Reports persistent elevated glucose and carbohydrate cravings.
Hematologic/Lymphatic	N/A
Allergic/Immunologic	N/A
Other

Objective:   

Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. 

·
What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.  

This 70-year-old female patient presents with diabetes as evidenced by a FBS of 115 

and a HgbA1C of 6.9. A HgbA1C level equal to 6.5% or greater indicates a diagnosis of diabetes mellitus 

(Centers for Disease Control and Prevention, 2023). The patient is currently at considerable risk for cardiovascular disease due to her borderline total cholesterol level of 200, LDL of 100, and HDL 37. The patient’s height is 5’2″ and weight is 176 lbs, BMI is 32.2 as per CDC (Centers for Disease Control) guidelines patient is obese which also contributes to cardiovascular disease (Centers for Disease Control and Prevention, 2022). The normal weight for the height of this patient is between 101lbs-136lbs (Centers for Disease Control and Prevention, 2022). According to Healthline, total cholesterol levels should be less than 200, LDL less than 100, HDL greater than 60, and triglycerides less than 149 for adult patients (2021). The patient has also been experiencing high blood pressure, BP 146/83 upon arrival. The patient has currently been taking lisinopril 10 mg daily for hypertension, atorvastatin 20 mg daily for 7 years for hyperlipidemia and Ozempic 1 mg injection weekly for three years for hyperglycemia. 

The patient has also been taking Abilify 5 mg daily for 6 years for depression. During this time, the patient gained twenty-five pounds and required an increased dose of Ozempic and atorvastatin. The patient has been unable to lose the weight she gained and reports closely monitoring dietary intake due to persistently increased glucose levels and carbohydrate cravings. The patient’s states depression slightly improved, however, anxiety has not improved and now the patient is having trouble leaving the house alone.  

According to the patient’s assessment, my treatment plan would be to continue Ozempic 1 mg injections weekly for diabetes management and add metformin IR 500mg PO BID with meals (Corcoran & Jacobs, 2023). Patient to check finger stick blood glucose levels 1-2 times daily on an empty stomach. Recommend the patient to a diabetes education program. To manage her cholesterol levels, I would titrate her atorvastatin from 20 mg to 40 mg PO daily. Re-check patient's lipid levels in 2-4 weeks (Drugs, 2023). To manage her high blood pressure, I would increase her lisinopril to 10 mg PO BID as a study shows that prescribing lisinopril twice daily vs once daily shows more improvements in SBP. Mean adjusted SBP reduction was 10.2 mm Hg greater in the twice‐daily cohort compared with the once‐daily cohort (Tsai et al., 2017). The patient will be coming back for follow-up in 2-4 weeks for further treatment outcome and if necessary, treatment plan adjustment.  

The patient has chronic depression that has improved slightly; however, she does voice increased anxiety and new symptoms of fear of going out alone since her husband died seven years ago. The patient is now restricting herself from going out for walks and exercise. She is starting to exhibit symptoms of agoraphobia. The patient is currently taking Abilify 5 mg PO daily for 6 years. Typically, second-generation antipsychotics are not the first line of treatment for depression, they are used once they have tried many antidepressants with no effect. I suggest treatment augmentation with an antidepressant. Zoloft is an SSRI that does not counteract Abilify, start Zoloft at 25 mg PO daily and increase the dose weekly as needed. Zoloft is used for depression and social anxiety disorder (Psych Central, 2021). The patient will also benefit from psychopharmacology, psychotherapy, cognitive behavioral therapy. 

Lastly, lifestyle change recommendations include diet and exercise modification. Work your way up to 150 minutes of moderate-intensity aerobic activity each week. This could be brisk walking 30 minutes a day, 5 days a week. Or you could do 75 minutes of vigorous-intensity aerobic activity each week, such as swimming laps. Regular physical activity provides immediate and long-term 

health benefits.Links to an external site.
 Physical activity and weight loss will Improve sleep quality, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and 

several forms of cancerLinks to an external site.
. It can help reduce arthritis pain and associated disability, reduce the risk for osteoporosis and falls, and reduce symptoms of depression and anxiety (Centers for Disease Control and Prevention, 2023). 

·
If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?  

 Yes, as a practicing PMHNP for the state of Pennsylvania, prescribe drugs, devices, and Schedule II-V controlled substances if there is a written collaboration agreement with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.).  

References: 

Balaram, K., & Marwaha, R. (2023). Agoraphobia.
 NIH. 

https://www.ncbi.nlm.nih.gov/books/NBK554387/Links to an external site.
 

Centers for Disease Control and Prevention. (2022). Adult BMI calculator. CDC. 

https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Diabetes tests. 
CDC. 

  

https://www.cdc.gov/diabetes/basics/getting-tested.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Physical activity for a healthy weight. 
CDC. 

https://www.cdc.gov/healthyweight/physical_activity/index.htmlLinks to an external site.
 

Corcoran, C., & Jacobs, T.F. (2023). Metformin. 
NIH. 

https://www.ncbi.nlm.nih.gov/books/NBK518983/Links to an external site.
 

Drugs. (2023). Atorvastatin dosage. 

https://www.drugs.com/dosage/atorvastatin.html#Usual_Adult_Dose_for_HypertriglyceridemiaLinks to an external site.
 

Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. PACNP. 

https://www.pacnp.org/page/ScopeofPractice#:~:text=In%20Pennsylvania%2C%20an%20NP%20may,collaboration%20agreement%20with%20a%20physicianLinks to an external site.
. 

Psych Central. (2021). Zoloft: What you want to know? 

https://psychcentral.com/drugs/zoloft#basicsLinks to an external site.
 

Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and 

safety of twice- vs once-daily dosing of lisinopril for hypertension. 
Journal of clinical hypertension (Greenwich, Conn.), 
19(9), 868–873. https://doi.org/10.1111/jch.13011 

Unit 7 Discussion Case Study MV

What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Support your answer with research-based evidence.

In managing this patient's weight concern, a comprehensive approach that addresses both behavioral and pharmacological aspects would be necessary. First and foremost it's crucial to evaluate if the patient is prepared to make changes and how motivated she is to lose weight. We can use motivational interviewing techniques to delve into her reasons, for wanting to shed pounds and uncover any obstacles or difficulties she might encounter (Bischof et al., 2021). To address her worries, about how her weight might affect her ability to care for her child it could be advantageous to involve a team of professionals that includes a registered dietitian, an exercise specialist and a psychologist or therapist. The dietitian can work with the patient to develop a personalized meal plan that takes into consideration her busy schedule and frequent eating out habits. Emphasizing portion control, incorporating healthier food choices, and encouraging mindful eating practices have been shown to be effective in managing obesity (Foster et al., 2018). In terms of physical activity, an exercise specialist can help the patient create an individualized exercise routine that is feasible given her current responsibilities as a stay-at-home mother. Promoting regular physical activity has been found to aid in weight loss so finding activities that she enjoys and can incorporate into her daily routine will enhance adherence maintenance (Posadzki et al., 2020).

What would be our approach to the sexual side effects she is experiencing?

Regarding the sexual side effects experienced by the patient, it is crucial to address these concerns openly and compassionately. It's important to determine whether the issues are primarily caused by medication use or if they're influenced by factors, like stress or relationship dynamics. It might be beneficial to educate the patient about how fluoxetine and olanzapine can affect sexual functioning. If it is determined that the medication is causing these problems switching from fluoxetine to another antidepressant that has a less impact on sexual function could be considered. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine have been linked to sexual dysfunction (Yuan et al., 2021). Bupropion, which is an atypical antidepressant, with a lower likelihood of causing sexual side effects could be an alternative option worth exploring (Montejo et al., 2019).

If you suggest additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommend?

Before suggesting any additional medication options such as Bupropion, it is essential to review prescribing laws specific to Illinois. As a PMHNP prescribing additional medication for the above concerns would depend on state laws. According to the Illinois Nurse Practice Act (2017), advanced practice registered nurses (APRNs) including PMHNPs have prescriptive authority. However, there are specific conditions and restrictions outlined in the Act (AANP, 2022). Therefore, it is necessary to review the current regulations and guidelines set forth by the Illinois Department of Financial and Professional Regulation (IDFPR) to ensure compliance with prescribing laws when considering Bupropion as a treatment option for this patient (Kleinpell et al., 2023). Psychiatric Mental Health Nurse Practitioners (PMHNPs) in Illinois have prescriptive authority to reduce practice. Illinois state law requires a career-long regulated collaborative agreement with a psychiatrist in order for the NP to prescribe medication. The nurse practitioner-psychiatrist collaborative practice agreement outlines their working relationship. It describes the categories of care, treatment, and procedures the nurse practitioner expects to perform (AANP, 2022). In Illinois, psychiatrists are not required to be physically present with the PMHNP. The psychiatrist must be available for consultation whether in person or by phone. A collaborating psychiatrist and PMHNP are required to meet at least once a month (AANP, 2022).

Include the subjective and objective information in this post.

Subjective information:

The patient reports concerns about her weight and its impact on her ability to care for her disabled child after her husband's death. She has tried numerous 'fad diets' without long-term success, losing only 15 pounds at most and maintaining it for three months. The patient expresses feelings of shame related to sexual dysfunction, specifically difficulty achieving orgasm during intimate moments with her husband.

Objective information:

The patient's objective data include being morbidly obese at 340 pounds with a height of 5'5″. She also has type II diabetes, hypertension, and hyperlipidemia. Additionally, she eats out frequently due to her children's busy schedules and leads a sedentary lifestyle with no regular physical activity.

References

American Association of Nurse Practitioners (2022). State practice by type. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-typeLinks to an external site.

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0014Links to an external site.

Foster, D., Sanchez-Collins, S., & Cheskin, L. J. (2018). Multidisciplinary team–based obesity treatment in patients with diabetes: Current practices and the state of the science. Diabetes Spectrum, 30(4), 244–249. https://doi.org/10.2337/ds17-0045Links to an external site.

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during covid-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.

Montejo, A., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640Links to an external site.

Posadzki, P., Pieper, D., Bajpai, R., Makaruk, H., Könsgen, N., Neuhaus, A., & Semwal, M. (2020). Exercise/physical activity and health outcomes: An overview of cochrane systematic reviews. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09855-3Links to an external site.

Yuan, S., & Deban, C. E. (2021). Ssri-induced hypersexuality. American Journal of Psychiatry Residents' Journal, 16(3), 9–12. https://doi.org/10.1176/appi.ajp-rj.2021.160305Links to an external site.